Provider Demographics
NPI:1326232521
Name:RESIDENTIAL CONCEPTS, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:513-724-3841
Mailing Address - Street 1:4073 TOLLGATE RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3328
Mailing Address - Country:US
Mailing Address - Phone:513-724-3841
Mailing Address - Fax:513-724-0786
Practice Address - Street 1:4073 TOLLGATE RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-3328
Practice Address - Country:US
Practice Address - Phone:513-724-3841
Practice Address - Fax:513-724-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1300256320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2000702Medicaid